Direct primary care – DPC
Direct Primary Care…Whaaa?
Direct Primary Care or DPC was not always a familiar concept for me, and I am sure many of you are wondering exactly what this is. In this post I will attempt to define DPC, compare DPC with traditional fee for service (FFS) medicine, and highlight the benefits for you as the client who chooses to be a part of DPC.
So what is FFS and DPC?
In contrast to the traditional FFS model in which medical practices charge a fee for each service rendered and typically collect payment through third party insurers, DPC basically cuts out the middle man, accepting direct payment from the client often in the form of an affordable monthly fee. FFS based systems require considerable costs for the practice such as axillary staffing for processing insurance claims. To compensate for these costs, providers need to maintain high productivity each day to meet these financial demands. Thus FFS forces and promotes high patient volume. In addition to higher costs, the documentation required by insurance companies is considerable and consumes a fair portion of the provider’s day. Administrative requirements and high patient volume equates to less time available for the patient during his or her visit, poor patient satisfaction, and inflated health care costs. DPC offers a meaningful alternative to FFS insurance billing for the client as well as the provider.
What are some of the benefits that can be expected by choosing DPC?
Eliminating high costs involved in processing claims, affords a DPC practitioner the ability to lower business overhead and reduce documentation requirements, allowing the practice to offer affordable health care. Also, in a DPC system, high patient volume is not a necessity. The provider is able to have a smaller patient panel. For example, a practitioner in a traditional FFS model usually has about 2-3,000 patients on his or her panel, in contrast to 600-800 patients that DPC providers aim for. Lower business expenses result in decreased health care costs, often less than what someone might pay for a copay at a visit or a monthly insurance premium. A main Feature of DPC is entering into a financial as well as trustful relationship with the practitioner who is there as your advocate, taking the time to complete proper assessments, and reduce unnecessary medical testing. You as the client gain more time with your provider. Due to a lower census, the provider can often spend up to an hour or more with each patient, as well as be available for 24/7 access to care.
So how does health care become affordable in a DPC system?
Again business overhead is lowered, allowing providers to charge less for their services. Being free from a network, the provider is also able to contract with pharmaceutical and radiology facilities for wholesale prices for medications, supplements, and imaging procedures. So practices may charge a higher monthly to fee to cover these basic costs while others charge a lower monthly fee for physician access, however labs and imaging or possible additional costs incurred.
What if I need specialty care of hospitalization?
DPC is not a replacement for some types of insurance. It would behoove you to carry a “wrap-around” or high deductible catastrophic policy. However, the costs of these polices and DPC for your primary preventive care is usually less than paying for full health care coverage. Some DPC clinics have contracted with specialty providers to offer reduced rates for their services; an option for those without insurance.
Here is an example explaining the differences in costs from Forbes (2016):
Joyner, a healthy middle-class female living in the Raleigh, says she used about $500.00 worth of Health care last year, while paying over 9,500 in yearly premiums with a 3,500 deductible. So basically she was paying $9500 for her annual physical and a few prescriptions.
Is this the future of health care?
DPC is gaining traction in the United States. With some beginning to make observations such as this quoted by the Wall Street Journal:
“The new system should be fully consumer driven, empowering individuals to be the surveyors and purchasers of their care. Past reforms in this direction became stilted and ultimately incomplete, but the current moment offers a chance to truly rebuild from the ground up…”
Those involved in the movement are working towards legislation that with further promote this model of care, such as having certain government programs recognize DPC providers.